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year 5 > Rhuematology > Flashcards

Rhuematology Flashcards

1
Q

What are some seronegative spondyloarthropathies?

A

Psoriatic arthritis, ankylosing spondylitis, reactive artheritis, enteropathic arthropathy, juvenile idiopathic arthritis

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2
Q

What is scleroderma and what are the types?

A

Thickening of skin and involvement if visceral organs.
Diffuse cutaneous (systemic sclerosis) - Anti-ScL70
Limited (CREST) - anti-centromere
Localised scleroderma

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3
Q

What dies CREST syndrome stand for in limited scleroderma?

A

Calcinosis, Raynauds, oesophgeal involvement, sclerodactyly, telangiectasia

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4
Q

How might cutaneous vasculaitis present?

A

Petechiae, palpable purpura, macules, haemorrhagic bullae, SC nodules, urticaria

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5
Q

What therapies can be used in an acute attack of gout?

A

1st line - High dose NSAIDs

Colchicine, steroids (IA or IM), analgesia

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6
Q

What therapies are used for chronic gout?

A

Urate lowering therapies:

Allopurinol, Febuxostat

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7
Q

What medications can put you at risk of gout?

A

Aspirin, cyclosporin, diuretics, nicotinic acid

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8
Q

What conditions are associated with pseudogout?

A

Hyperparathyroidism, hypo- or hyperthyroidism, haemochromatosis, renal impairment, OA

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9
Q

What condition is associated with PMR?

A

GCA

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10
Q

What condition is associated with myasthenia gravis?

A

Thymoma

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11
Q

What is Myasthenia gravis?

A

AI condition causing muscle weakness that gets progressively worse with activity and improves with rest
ACh receptor antibodies

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12
Q

How might a patient with MG present?

A

Progressive weakness with repetitive movements:
Worse symptoms at the end of the day
Ptosis, diplopia, facial weakness, slurred speech, jaw fatigue, weak swallow

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13
Q

What examinations might you do in suspected MG?

A 
Repeated blinking - ptosis 
Prolonges upward gaze - diplopia
Repeated abduction - weakness
Check for thymectomy scar
Test FVC*
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14
Q

What is a Myasthenic crisis?

A

Life threatening acute worsening of Sx, triggered usually by RTI
May need BiPAP or intubation due to weak respiratory muscles and risk of respiratory failure
IV immunoglobulins or plasma exchange

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15
Q

What is Ankylosing spondylitis?

A

A chronic (>3 months) inflammatory disease of the spine and sacroiliac joints of unknown aetiology

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16
Q

How might a patient with ankylosing spondylitis present?

A

Man < 30, peripheral arthropathy, limited chest expansion,
Reduced lumbar movements, question mark spine (thoracic kyphosis and neck hyperextension),
Gradual onset lower back pain, worse at night with stiffness in the morning >30min relieved by exercise,
Pain radiates from sacroliliac joints to hip/buttocks,
Usually improves towards end of the day

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17
Q

What disease tools can be used in Ank spond?

A

Bath AS disease activity index (BASDAI)
Bath AS functional index (BASFI)
Bath AS metrology index (BASMI)

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18
Q

What is reactive arthritis?

A

An inflammatory, sterile arthritis usually in the lower limbs following an infection elsewhere in the body
?enteric infection - salmonella, shigella, campylobacter
?GU - Chlaymidia, gonorrhoea, mycoplasma genitalium

19
Q

How might a patient with reactive arthritis present?

A

Systemically unwell
2-6 weeks post-infection
Arthritis, conjunctivitis, urethritis
Dactylitis, anterior uveitis, sacroilitis, keraroderma blenorrhagica

20
Q

What are the different types of psoriatic arthritis?

A 
Oligoarthritis
Asymmetric DIP
Symmetrical polyarthritis
Psoraitic spondyloarthritis
Arthritis mutalins
21
Q

What is sjögrens syndrome?

A

AI chronic inflammation of exocrine glands

Dry eyes and mouth

22
Q

What antibodies can be seen in sjögrens?

A

Anti-Ro

Anti-La

23
Q

What is a potential harmful problem associated with Anti-Ro in pregnancy?

A

It can cross the placenta and cause neonatal lupus and complete heart block

24
Q

What is SLE?

A

A multisystem AI disease

Remitting and relapsing

25
Q

How might a patient with SLE present?

A

Photosensitive butterfly rash / malar rash
Pain and tender PIP joint
Raynauds
Fever, fatigue, weight loss, hair loss, lymphadenopathy

26
Q

What ab can be seen in SLE?

A

> 95% have ANA
Anti-dsDNA
Anti-Ro, Anti-La, Anti-RNP, anti-SM, anti-phospholipid

27
Q

What is RA?

A

A multisystem inflammatory condition characterised by symmetrical polyarticular arthritis, usually involving the hands, follows a chronic course and results in disability

28
Q

How might you assess disease activity in RA?

A

DAS-28

29
Q

How might you manage a patient with RA?

A

1 - NSAIDs (only for inflammation, they do not suppress disease activity)
Cox2i - etoricoxib
Steroids - PO/IM/IA
2- cDMARDs (slow onset, suppress disease activity) - methotrexate, sulfalazine, leflunomide
3 - bDMARDs (suppress disease activity)- abatercept, infliximab, enteracept

30
Q

What is a important side effect of Methotrexate?

A

Pulmonary fibrosis

31
Q

What is a important side effect of Leflunomide?

A

HTN, peripheral neuropathy

32
Q

What is a important side effect of Sulfasalazine?

A

Male infertility (reduced sperm count)

33
Q

What is a important side effect of Hydroxychloroquine?

A

Nightmares, reduced VA

34
Q

What is a important side effect of anti-TNF?

A

Reactivation of TB or hep B

35
Q

What is a important side effect of Rituximab?

A

Night sweats and thrombocytopenia

36
Q

How would you manage reactive arthritis - mild, mod and severe?

A

Mild- NSAIDs and simple analgesia + bed rest
Moderate - NSAIDs, Joint aspiration, steroids
Severe - DMARDs?
Its usually self limiting and can take 6months to resolve *

37
Q

What is JIA?

A

AI inflammation

Diagnosed when a child <16 has arthritis without a known cause/ another cause for >6 weeks

38
Q

What are the different types of Jia?

A 
Systemic
Polyarticular 
Oligoarticular
Enthesis related arthritis 
Juvenile psoriatic arthritis
39
Q

What would make u think of systemic JIA or stills disease?

A

Subtle salmon pink rash
High swinging fevers
Joint pain and inflammation

Lymphadenopthay, pericarditis, weight loss, splenomeagly, pleuritis

40
Q

What is a life threatening complication of systemic JIA or stills disease?

A

Macrophage activation syndrome
Severe activation of the immune system with a massive inflammatory response.
An acutely unwell child with
DIC, anaemia, thrombocytopenia, leukopenia, a non blanching rash ans a LOW ESR

41
Q

What drug can cause drug induced lupus? (clue, tb abx)

A

Isoniazid

methyldopa, enteracept, hydralazine, phenytoin

42
Q

What protein is mutated in marfans?

A

Fibrillin - AD

43
Q

What is a side effect of hydroxychloroquinine (used in SLE)?

A

Severe and permanent retinopathy - ‘Bulls eye retinopathy’

So need to monitor VA

44
Q

How can CES present?

A

Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence

year 5 (9 decks)

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